As most of you know by now, I have been through Casodex, Eligard, Abiraterone, Docetaxel, Lu-177 and radiation therapy thus far.
My remaining options are Cabazitaxel and Enzalutamide.
Any idea which should I take first and why ??
Many thanks for any reply anyone may care to give.
Tall Allen recommends starting with Docetaxel. His logic as I recollect is based in part, on the reasonable expectation that the insurance companies are less likely to get in the way if you start with Docetaxel first.
It also happens to be the cheapest of the expensive options.
Most likely you will end up starting with Casodex & Eligard first. And I think also concurrent with Docetaxel and/or radiation?
Radiation is just an entirely separate decision. Its often a choice between radiation and a radical prostatectomy.
LU177 is sort of heavy duty with some heavy duty potential side effects. Not something you are likely to consider early one. And not yet so available in the US (but available in Germany and Australia)
I welcome any corrections to the above.
It's not because of insurance companies. It's because chemo takes less time - you can get to both therapies in a few months. Sometimes taxanes reverse some kinds of resistance. Moree importantly, a recent clinical study found that cabazitaxel before enzalutamide had a greater "clinical benefit rate" than those patients who received second-generation androgen antagonists (abiraterone or enzalutamide), 88% vs 70%, p=0.043. "Clinical benefit rate" was defined as a PSA decline ≥50% (PSA50), objective response (OR), or stable disease (SD) ≥ 12 weeks.
urotoday.com/conference-hig...
Also, because you've already had abiraterone, enzalutamide isn't likely to work very long. The taxanes before the (first) second line hormonal seems to work better. I would guess that is all the more true before the (second) second line hormonal:
sciencedirect.com/science/a...
clinical-genitourinary-canc...
Although you've had lung mets, rules may be different in India about getting Xofigo. Provenge with it may be good. A bone strengthening agent (Zometa or Xgeva) may be good. Try it with Celebrex.
Sometimes estrogen patches work even after failure of other hormonals. Can you get darolutamide or apalutamide there for mCRPC (they're not yet approved for that in the US)?
There is not definitive data about the sequence of treatments in castration resistant cancer. i t seems that after failing one anti androgen it may be beneficial to do chemo before starting another
ncbi.nlm.nih.gov/pubmed/302...
If you have bone metastases and you do not have visceral metastases you could also be treated with Xofigo. You could also discuss treatment with Provenge. These 2 treatments may offer some survival advantage.
Thank you very much, tango65.
Best of luck.
Thanks again, tango65. You have always been very helpful.
Cheers and all the very best to you.
I would also suggest chemo first, for the reasons already mentioned. Also, I've read that tumors which don't get much blood/oxygen are more resistant to treatment, so exercise if you can to increase blood flow. I've also read that nitroglycerin might help with that too, and believe pjoshea13 may have posted about that.
As I've read more about Abiraterone, how it's metabolized, and that one of its metabolites can activate T receptors, it seems to me that differences in individual response may be partly due to genetic differences in how the drugs are metabolized. Which is to say there's some hope that a 'lutamide might work for you when Abiraterone didn't.
Glad to see you are still fighting this! I'm happy every time I see you post or reply and know you're still with us.
I also think Cabazitaxel is the way to go now.
Regarding bone health drugs I am on Chris Parkers side:
urotoday.com/video-lectures...
Thank you very much, GP24.
What happened when you took Docetaxel?
I have replied to that several times in the last 5/6 months.
Sorry, too weak and tired to keep repeating the same crap.
Just trying to help.
Thank you for trying to help.
I have found it useful to keep a word document of paragraphs that I’ve written in the past advising people on IP6. Copy and paste from your old post the most pertinent material and put it onto a single word document and then copy and paste it in to your comments when they are being asked about once again. Simplify and life will be more bearable and your information will reach more people.
Thanks, CalBear74.
I'll pass. If I am asked questions that I have already repeatedly answered, I'll just ignore in future. But, thanks for the advice.
Hi Carlos,
It would be helpful if you could talk to people who have taken both Docetaxel and Cabazitaxel, maybe then you can figure out if Cabazitaxel works even when initial Docetaxel failed. I can recall Fairwind being one who had both.
That said, I hope you will be able to make the right choice. Goodluck!
Hi Cheerr,
The problem with that is that treatments work differently for different people.
I have more or less made up mind to give Cabazitaxel a try first. What I have to figure out is exactly what dose should I start with and when to increase or decrease it.
Also, unlike Docetaxel, I will not permit my MO to insist on 6 straight cycles without checking the efficacy of the treatment. PSA tests and a PSMA PET-CT scan should provide enough evidence whether the treatment is working or not. Maximum two cycles before checking, whether the quack approves or not. Its my life, my money, my decision.
Thanks for your help. All the best to you and your Dad.
Yes one thing I’v definitely learned by now is no two people have the same disease even if all the numbers match.
Good decision on proactive approach to have scans and PSA tested. (Include LFT for ALP as well).
And lastly I totally agree with you, I have always taken various tests like CBP, PSA, ALP, Calcium etc at different time intervals even when the MO felt no need to check them and it did help.
All the very best to your Dad, Cheerr !!!
I’m definitely a novice when it comes to all the various drugs, but consider throwing Apalutamide into the list of options...works for me
Apalutamide (Erleada), I think is meant for non-metastatic prostate cancer patients.
I was metastatic from the time the cancer was detected in me approx 19 months back.
I see that Apalutamide has got FDA approval for metastatic prostate cancer patients as well as recently as 17th September, 2019.
Thanks CRK2.
I will check it out for sure. Cheers !!
Someone I know with mets had a 50% drop in PSA with Docetazel+ Enza
And I know one person in particular who claims to have his disease in remission for more than two years on just Abiraterone.
However, thus far, nothing seems to have worked for me 
you’re welcome
This is a case of Docetaxel given togather with Enzulatamide and his PSA dropped 50%. Chemo for some knocks down ARV resistance from Abi use. Some of us last longer than others on Abi. If you have Abi resistance like me you could try it with Dexomathosone which may resensitize Abi for a while longer. I am i the same boat. Best of luck.
Thank you. I have tried Abi with Dexa and it did not work for me
I appreciate your concern and thoughtfulness.
Cheers, Sukumaran !!!
You already know that I know nothing. We are all rooting for you whatsinaname. Hope you are enjoying today. Monte
Well you know that I know that you know that you don't know nothing....
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 09/26/2019 6:55 PM DST
Cheers, monte1111. Today is not so bad 
HI Carlos,.. Thinking of you and happy you have some more treatment options. I think I told you my husband Sam qualified for the Lu-177 trial, but was denied. Sam is still part of the trial, it's standard of care ... He was put on Xtanti. Sam was off treatment for a few months..PSA went from 49 when chemo quit working. Then went to 89 to 500 , now last week's blood work it was at a thousand... Sam has only been on Xtandi for three weeks., we are hopeful this Xtandi will work for a while ?
Dr. at Jefferson in phily seems to think it will work for a good while .. 🙏🏻 He's head of oncology. at Jefferson,...
Keep fighting Carlos, never give up and never give in.
Sincere best wishes coming your way for you and your wife .. Take care.. Keep us posted.
Lynn
Thank you very much, Lynn.
Best of luck to you and off course to Sam.
I don’t know what’s best for you . I do know that you’re not giving up . You ‘re fighting your ass off .. sounds Chemo is the way to go . May it help you much . You are writing a lot of chapters in treatments . Did you get a break ? A vacation you said? Take care ..
Unfortunately, no vacation as yet. Too sick to go.
First, we planned to go to Paris and France. Had to cancel that.
Next, we planned New England Fall Foliage Tour. Had to cancel that.
Next we planned Bangkok, Hua Hin and Phuket. Had to cancel that.
Then, we planned the hill stations of South India. Had to cancel that.
Finally, we thought we'd take a staycation at The Oberoi, Mumbai. Had to cancel that.
That is the sad story of my vacation plans for July-Oct, 2019.
Sh**! I’m sorry man ... Dear Sir you’ve been in the trenches fighting for your life ... Mama Mia ! You deserve a light to shine down and heal you ... I pray for mercy for you ... I’m still hiding in the field trying to keep my head down and out of APC ‘s laser site .. Throw the kitchen sink at it . Keep fighting brother .... 🚣🏻♀️🚣🏻♀️🚣🏻♀️
Thank you very much, Lulu700.
Its good to have friends like you.
All the very best to you too.
Very kind .thank you ... Take care .... 😂
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